Benjamin Franklin famously noted that an ounce of prevention is worth a pound of cure — a lesson the U.S. medical industry has learned the hard way.
Over the last several weeks of the coronavirus pandemic, concerns have mounted that the U.S. has neither the beds nor ventilator capacity to handle a wave of critical care patients crashing into its infrastructure.
It was that shortage of ventilators, hospital beds and other necessary equipment, Karen Webster noted in a conversation with ResMed’s Chief Medical Officer Dr. Carlos Nunez, that ultimately drove the economic shutdown we are all now living through. It also has been what has elicited the most shock: How did the largest economy on earth get caught so flat-footed when it came to such critical supplies?
Nunez, whose smart medical equipment firm ResMed responded to the crisis by radically refocusing all its production and distribution efforts to getting more ventilators into the hands of providers worldwide, knows an awful lot about that supply gap — and trying to fill it. He also knows the two main reasons it existed in the first place.
The first is human nature. His first major emergency as a medical professional, he noted, was Hurricane Andrew, which devastated South Florida in 1992 because the city was unprepared for a Category 5 hurricane. The city hasn’t had a major hurricane for over two decades, he noticed, and the unfortunate side of human nature is that it often fails to prepare for emergencies in favor of just responding to them as they happen.
Moreover, he noted, keeping a stockpile of ventilators is a very tricky thing. The rumors that the federal stockpile is made up of old, malfunctioning equipment are false — previous work experience leads him to know that stockpile is continually refreshed. But ventilators are not an easy or inert stockpile to keep.
“In the modern era, these ventilators are pretty complicated electromechanical devices that are computer controlled and driven with software and firmware,” he said. “They get updates and they get patches and there's a lot of maintenance involved. The government does not have an easy job because if you stockpile too many, the maintenance becomes overwhelming. If you stockpile too few the stock is not really useful. You've got to find that happy balance.”
He said finding it and building up resources quickly has been a massive concerted effort among ResMed and other ventilator manufacturers worldwide as well as officials from all levels of government.
And, he noted, nothing about COVID-19 has been a pleasant experience. It has certainly been an educational one, both in terms of what they’ve learned in the short term about crisis management, and in laying the long-term groundwork for telemedicine’s future.
Responding Versus Preparing
If you look at places like California, New York and Washington, he noted, early slower moves in combating the COVID-19 crisis meant that they essentially “had no opportunity to prepare;” all they could do was respond because they were already a hotspot and their questions were all about mitigating the crisis.
California, he noted, sidestepped a lot of the worst early forecasts, and while New York was ultimately hit very hard, its entire medical infrastructure didn’t break down. The response phase, Nunez said, is driven by that on-the-ground data and the needs of the situation — and we’ve seen that effective response yield positive outcomes. The initial mortality forecasts were above a 250,000; they are now well below 100,000 for the U.S.
And that, he noted, isn’t a sign that the epidemiologists made bad early models; it is a sign that early responders moved efficiently and effectively.
“A good model is supposed to change,” he said. “When you see a really scary model with a curve that looks crazy, you're supposed to do something about it. So, the next time you run the model, the curve looks better.”
Moreover, while hotspots are responding, the places that have not become hotspots now have time to prepare with both new models and better data on effective response. The system got behind, but it quickly came together to move the models. The industry can move quickly when it has to, he noted.
“People are starting to realize this COVID-19 world we're emerging into is fully ready to accept things like telemedicine and telemonitor and embrace digital health because we've been forced to accept it in the short term and people like it,” Nunez said.
In the past, the challenge has always been getting people to put that initial toe in the telemedicine water with a connected device or a virtual session with a physician. Now, the appeal of going to a doctor’s office for all but the direst necessities has dropped to near zero, Nunez said, and people are open to new ideas. He said a friend of his in primary care has seen his telemedicine visits go from a few hundred a month to over 1,000 a week.
“People are using it once and saying, ‘Wow, I don't have to leave my house. I don't have to sit in a waiting room for 45 minutes. I don't have to drive to the office. You can ask me the same questions you’d ask me there and refill my prescription.’ They realize this is just as good and a lot easier,” Nunez said.
It’s easier and better, he noted. Taking an example from sleep apnea treatment, which is what ResMed specializes in when it isn’t crash-producing ventilators, without connected device support, people use their CPAP machine about 55 percent of the time. Add connectedness that lets their physician monitor their use and send reminders and that number jumps to a 75 percent use rate. Add an app that lets customers monitor their own progress and the use rate goes above 80 percent.
Using digital technology and leveraging connectedness can make patients both more likely to seek care when they need it and engage in healthy habits like using their CPAP machine or taking their meds.
“We’re ready, I think, now for the first time to really embrace this technology,” Nunez said. “And, I think, it will change how medicine gets done for the better.”